Foreword by the Cabinet Secretary for Health, Wellbeing and
Sport

I am delighted to be able to endorse this emergency department (
ED) capacity
management guidance in partnership with the Royal College of
Emergency Medicine. The guidance, which sets out the risks of
ED crowding and the
effect on safety and patient care, offers a framework of escalation
to proactively manage and prevent crowding in
ED and/or
assessment areas, along with implementation tips for
NHS boards to
consider.

The delivery of the four-hour emergency access target is a key
ministerial priority and is about improving outcomes for people who
are using services. The people of Scotland have told us what they
want from health and social care services - care that is
person-centred, safe and effective - and I am committed to ensuring
that we do all we can to put in place sustainable measures,
processes and practices to achieve better care in every part of the
health and social care system in Scotland.

While the most visible and widely publicised example of pressure
and patient care delays are patients on trolleys in
EDs, this is not
just an
ED problem;
crowding in the
ED affects various
parts of the hospital in different but interrelated ways. We
recognise the multi-disciplinary issues and we must do more to
minimise the risk to patients on a whole-system, integrated basis.
This guidance, while offering a significant opportunity for
NHS boards to
ensure that front-door services operate effectively to avoid
crowding in the
ED, also supports a
whole-system approach to eliminating crowding and sits within the
context of a wider programme of work focused on improving
unscheduled care.

I would strongly encourage all boards to embrace this guidance
and develop standardised processes for managing
ED capacity that
will help to reduce variation and embed a culture of early referral
and proactive capacity management, ensuring that patient flow is
high-quality, safe and effective.

This guidance complements the work on the 6 Essential Actions to
Improving Unscheduled Care, which has been created with our
partners, including the Royal College of Emergency Medicine, to
improve unscheduled care nationally.

The 6 Essential Actions national programme has accepted an
ambition to support implementation of an escalation policy in every
acute site across Scotland. We look forward to working together
with you to eliminate crowding and in turn, improve the safe,
high-quality and effective person-centred care delivered to people
in Scotland.